术中联合监测技术在椎管内肿瘤切除术中的应用

目的评价应用神经电生理术中监测技术对预防椎管内肿瘤切除术中脊髓神经功能损伤的意义。方法对56例椎管内肿瘤患者行手术切除治疗,术中应用三种神经电生理技术全程监测。结果经过术中联合监测患者术后3个月随访神经功能改善30例,无变化24例,下降2例。结论椎管内肿瘤切除术中使用联合监测能及时反映出神经功能的变化,术中电生理变化指标变化与切后患者神经功能改变一致。联合监测提高了术中操作的安全性,能避免或减少并发症。     

功能定位结合CT定位射频热凝术治疗原发性三叉神经痛的中远期疗效

目的评估功能定位结合CT定位射频热凝术治疗原发性三叉神经痛的中远期疗效。方法选择60例原发性三叉神经痛患者,行功能定位结合CT定位射频热凝术,分别于术后1、6、12、18个月随访治疗效果、并发症和复发情况。结果疼痛缓解率术后1个月为96.67%(58/60),18个月为98.33%(59/60)。术后1个月55.00%(33/60)患者存在各种并发症,18个月时15.00%(9/60)患者仍有并发症,并发症主要为面部感觉减退。随访期间共复发4例(6.67%)。结论功能定位结合CT定位射频热凝术可提高卵圆孔和疼痛神经支的定位准确性,从而缩短手术时间,提高患者手术耐受性,改善治疗效果。     

亚低温条件下弥漫性脑损伤海马区凋亡蛋白酶激活因子1蛋白的表达

The influence of mild hypothermia on neural cell apoptosis remains poorly understood. Therefore, the present study established rat models of diffuse axonal injury (DAI) at 33 ℃. Morris water maze results demonstrated significantly better learning and memory functions in DAI rats with hypothermia compared with DAI rats with normothermia. Expression of apoptotic protease activating factor-1 in the hippocampal CA1 region was significantly lower in the DAI hypothermia group compared with the DAI normothermia group. Expression of apoptotic protease activating factor-1 positively correlated with latency, but negatively correlated with platform location times and time of swimming in the quadrant area. Results suggested that post-traumatic mild hypothermia in a rat model of DAI could provide cerebral protection by attenuating expression of apoptotic protease activating factor-1.     

射频热凝术与颅后窝探查手术治疗原发性三叉神经痛的疗效比较

目的 比较经皮半月节射频热凝术和颅后窝探查手术治疗原发性三叉神经痛的疗效.方法 回顾性分析126例三叉神经痛病人的治疗情况,其中经皮半月节射频热凝术(射频治疗组)治疗60例,颅后窝探查手术(颅后窝手术组)治疗66例.结果 射频治疗组术后有效率91.7%,颅后窝手术组为86.4%o颅后窝手术组三叉神经第1支病变病人术后7d并发症发生率显著低于射频治疗组(P = 0.033),但两组疼痛缓解度无明显差别;对于三叉神经第2、3支病变的病人,术后7d两组疼痛缓解度和并发症发生率无统计学差异.随访18个月,射频治疗组远期并发症发生率为15%,复发4例;颅后窝手术组远期并发症发生率为3%,未见复发.结论 颅后窝探查手术是治疗由三叉神经第1支病变引起的三叉神经痛的良好方法;对于由三叉神经第2、3支病变引起的三叉神经痛,经皮半月节射频热凝术和颅后窝探查手术疗效相当.     

亚低温对大鼠弥漫性脑损伤后海马CA1区Apaf-1蛋白表达和学习记忆功能的影响

目的 探讨亚低温对大鼠弥漫性脑损伤(DBI)后海马CA1区Apaf-1蛋白表达及大鼠学习记忆功能的影响.方法 选择雄性Wistar大鼠48只,按照完全随机数字表法分为正常组、假手术组、脑损伤组和亚低温组,每组12只.正常组不做任何处理;假手术组仅给予麻醉及头皮切开、缝合,但不致伤;脑损伤组和亚低温组根据Marmarou方法制作DBI模型,亚低温组大鼠损伤后用冰毯及冰袋物理降温,使大鼠肛温在15 min内控制至30.0～31.0℃,维持2 h.14 d后比较各组大鼠Morris水迷宫实验成绩,同时比较各组大鼠海马CA1区Apaf-1蛋白的表达.结果 正常组、假手术组、脑损伤组和亚低温组大鼠搜索安全岛的次数分别为(10.1±1.9)次、(10.3±1.8)次、(3.8±2.3)次和(6.9±1.1)次,差异有统计学意义(P<0.05).脑损伤组及亚低温组海马CA1区Apaf-1蛋白含量高于正常组及假手术组,其中脑损伤组Apaf-1蛋白含量明显高于亚低温组,差异均有统计学意义(P<0.05).结论 亚低温可能通过抑制神经细胞凋亡对脑组织产生保护作用,从而改善大鼠脑损伤后学习记忆障碍.

Abstract：

Objective To investigate the influence of mild hypothermia on the apoptotic protease activating factor-1 (Apaf-1) protein expression in the hippocampal CA1 area and learning and memory functions of rats after diffuse brain injury (DBI). Methods Forty-eight male Wistar rats were equally randomized into normal group, sham-operated group, brain injury group and mild hypothermia treatment group (n=12). Rats in the normal group did not receive any treatment; rats in the sham-operated group only received anesthesia, and incision and suture of scalp; rats in the brain injury group and mild hypothermia treatment group were induced the DBI models according to Marmarou method; and rats in the mild hypothermia treatment group were performed hypothermia with ice blanket and ice bag to control the rectal temperature within 30.0-31.0 ℃ for 2 h. After DBI for 2 weeks, the times of searching refuge platform and the protein expression of Apaf-1 were compared among the 4 groups. Results The times of searching refuge platform in the normal group, sham operated group, brain injury group and mild hypothermia treatment group were (10.1 ±1.9), (10.3±1.8), (3.8±2.3) and (6.9±1.1), respectively,with significant differences between each 2 groups (P<0.05). The protein expression of Apaf-1 in the brain injury group and mild hypothermia treatment group was obviously higher than that in the other groups (P<0.05), and significantly lower protein expression of Apaf-1 in the mild hypothermia rats was noted as compared with that in the brain injury rats (P<0.05). Conclusion Mild hypothermia might play a protective role by inhibiting neuronal apoptosis for rats with DBI through the Apaf-1 pathway,which can improve learning and memory abilities.     

皮层体感诱发电位监测在椎管内神经鞘瘤手术中的应用

目的评价术中皮层体感诱发电位（CSEP）监测对预防椎管内神经鞘瘤切除术中脊髓和神经根损伤的意义。方法对37例椎管内神经鞘瘤行手术治疗，术中应用CSEP全程监测。结果所有患者术后均未发生脊髓和神经根损伤并发症，症状和体征明显改善。结论椎管内神经鞘瘤切除术中使用CSEP监护能及时反映出脊髓功能的变化，提高术中操作的安全性，避免或减少术后并发症。     

体感诱发电位、运动诱发电位联合监测在脊髓髓内肿瘤切除术中的应用

目的：观察体感诱发电位（ SEP）、运动诱发电位（ MEP）联合监测在脊髓髓内肿瘤切除术中的应用效果。方法脊髓髓内肿瘤切除术患者36例,分别于切除前和切除后3个月进行SEP、MEP联合监测,并进行JOA评分以评价脊髓神经功能。比较分析髓内肿瘤切除后脊髓神经功能改善及无变化患者手术前后SEP、MEP指标。结果脊髓神经功能改善16例,未明显改变18例,下降2例。与术前比较,脊髓神经功能改善患者术后SEP-P40潜伏期缩短、波幅升高,MEP-AHB潜伏期缩短,P均＜0．05;脊髓神经功能未明显改变患者上述监测指标手术前后变化不明显（ P均＞0．05）。结论 SEP、MEP联合监测可反映脊髓髓内肿瘤切除术患者手术前后神经功能变化。